Member Rights and Responsibilities

Member Rights

  • You have the right to get accurate, easy-to-understand information to help you make good choices about you or your child's dentists and other providers.

  • You have the right to know how your child's dentists are paid. You have a right to know about what those payments are and how they work.

  • You have the right to know how MCNA decides about whether a service is covered and/or medically necessary. You have the right to know about the people in MCNA's office who decide those things.

  • You have the right to know the names of the dentists and other providers enrolled with MCNA and their addresses.

  • You have the right to pick from a list of dentists that is large enough so that your child can get the right kind of care when your child needs it.

  • You have the right to take part in all the choices about your child's dental care.

  • You have the right to speak for your child in all treatment choices.

  • You have the right to get a second opinion from another dentist enrolled with MCNA about what kind of treatment your child needs.

  • You have the right to be treated fairly by MCNA, dentists and other providers.

  • You have the right to talk to your child's dentists and other providers in private, and to have your child's dental records kept private. You have the right to look over and copy your child's dental records and to ask for changes to those records.

  • You have a right to know that dentists, hospitals, and others who care for your child can advise you about your child's health status, medical care, and treatment. Your child's dental plan cannot prevent them from giving you this information, even if the care or treatment is not a covered service.

  • Medicaid members, you have a right to know that you are not responsible for paying for covered services for your child. CHIP members, you have a right to know that you are only responsible for paying allowable copayments for covered services for your child, up to benefit maximum limits. Dentists, hospitals, and others cannot require you to pay any other amounts for covered services.

Member Responsibilities

You and MCNA both have an interest in seeing your child's dental health improve. You can help by assuming these responsibilities.

  • You and your child must try to follow healthy habits, such as encouraging your child to exercise, to stay away from tobacco, and to eat a healthy diet.

  • You must become involved in the dentist's decisions about you and your child's treatments.

  • You must work together with MCNA's dentists and other providers to pick treatments for your child that you have all agreed upon.

  • If you have a disagreement with MCNA, you must try first to resolve it using MCNA's complaint process.

  • You must learn about what MCNA does and does not cover. You must read your Member Handbook to understand how the rules work.

  • If you make an appointment for your child, you must try to get to the dentist's office on time. If you cannot keep the appointment, be sure to call and cancel it.

  • You must report misuse by dental and health care providers, other members, MCNA, or other dental or medical plans.

If you think you have been treated unfairly or discriminated against, call the U.S. Department of Health and Human Services (HHS) toll-free at 1-800-368-1019. You also can view information concerning the HHS Office of Civil Rights online at www.hhs.gov/ocr.